Key result
Preoperative AAA ≥6.5 cm is linked to ~103% higher secondary intervention risk without increasing endoleaks.
Why the study?
The study was conducted to identify the effect of abdominal aortic aneurysm size on endoleak development, secondary intervention, overall survival, and cause of mortality following elective EVAR.
Does preoperative abdominal aortic aneurysm size affect endoleak development, secondary intervention, and overall survival in patients undergoing elective endovascular aneurysm repair?
Cohort (n=517)
No
Does preoperative abdominal aortic aneurysm size affect endoleak development, secondary intervention, and overall survival in patients undergoing elective endovascular aneurysm repair?
Absolute Event Rate: 22.5% vs 17.3%
p-value: p=0.46
Preoperative AAA diameter does not significantly impact the overall rates of endoleak, secondary intervention, or survival after elective EVAR, suggesting patients with suitable anatomy can undergo EVAR regardless of large aneurysm size.
Larger pre-EVAR AAA size showed no link to endoleak or reintervention rates; leaves open whether size affects intervention timing in observational cohorts.
OBJECTIVE: The purpose of this study was to identify the effect of abdominal aortic aneurysm (AAA) size on endoleak development and secondary intervention after endovascular repair (EVAR), as well as to examine the effect on overall survival and cause of mortality. METHODS: Retrospective analysis was performed on all non-ruptured AAA treated by elective EVAR using FDA-approved endografts in our facility from July 2004 to December 2017. Patients were grouped into 3 cohorts based on preoperative aneurysm size: Group I (<5.5 cm), Group II (5.5-6.4 cm), and Group III (≥ 6.5 cm). Occurrences of endoleak, secondary intervention and overall survival underwent univariate and multivariate analysis. Cause of death data on deceased patients was similarly examined. RESULTS: A total of 517 patients were analyzed. There was no difference between size groups in the rate of endoleak (Group I 48/277, 17.3%; Group II 33/160, 20.6%; Group III 18/80, 22.5%; p = 0.46) or time until endoleak development. Univariate analysis showed no difference in the rate of secondary intervention (Group I 36/277, 13.0%; Group II 24/160, 15.0%; Group III 18/80, 22.5%; p = 0.11), time until intervention or number of interventions performed. Multivariate analysis showed an association with shorter time to secondary intervention for both Group III aneurysms (HR 2.03, 95% CI 1.11-3.73; p = 0.02) and female patients (HR 1.79, 95% CI 1.02-3.13; p = 0.04). There was no difference in overall survival, aneurysm-related mortality or overall cause of mortality. CONCLUSION: AAA diameter prior to EVAR was not associated with any differences in rates of endoleak or secondary intervention, and was not associated with poorer overall survival or greater aneurysm-related mortality. Patients with suitable anatomy for EVAR can be considered for this intervention without concern for increased complications or poorer outcomes related to large aneurysm diameter alone.
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Ferrel et al. (2021) conducted a cohort in Non-ruptured abdominal aortic aneurysm (n=517). Large preoperative aneurysm size (≥ 6.5 cm) vs. Small preoperative aneurysm size (< 5.5 cm) was evaluated on Endoleak development (p=0.46). Preoperative AAA diameter ≥6.5 cm was not associated with increased endoleak rates (22.5% vs 17.3%; p=0.46) but was linked to shorter time to secondary intervention (HR 2.03; 95% CI 1.11-3.73).
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